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410 Statement of Organization Recipient Committee - AmendmentStatement of Organization DJI.,Sr mp CALIFORNIA Recipient Committee 410 FORM Statement Type El initial ® Amendment ❑Termination —See Part 5 rornfflrlaIU-onlf Q Not yet qualified 01 0 Date threshold ECEI VED qualificaiion met Date qualification threshold met Date of termination yKirsten Squarcia at 2:57 pm, Oct 19, 202 - I.D. Number 2. Treasurer and Other PrincipalOfficers R BBERT MCCOY FOR COUNCIL 2020 BLOSSOM MCCOY srRl I r nncRr ,s (Nn roc ruxl CUPERTINO CA 95104 - " Slf.:r /IF WD[ ARIA, OIJTIPHONL 3VAMr or As S'S,ANr 1p'A. Jkl P., IF ANV CUPERTINO CA 95014 1IA, IN, 1,, pLl-!,i STRrf1ADF)%t r1DPo FOX) CITY .i',IF .'Ii, .__.A A r-_i I, % .. !'„I• �,, r�I; 11F lllklsol; 11011 WIiTRL LOMMI I IFL SAC 1111 NAME OF PFINLIPAk OF FI( E Ri Si STP F ET ADDRESS (No P D B(7RI Attach additional information on appropriately labeled continuation sheets. 3. Verification SDIT . CIrY i. :IPIL.)I A-11A1ODL PI _�NI 1 have used an reasonaoie diligence In pr penalty of perjury under the laws of the October 19, 2020 EsecutF-d a❑ By rfe�I�tcd an LRec,t,J on F«•oJ'ed cn UnIE October 19, 2020 By Dail By ML-NAiLI910I LUNIROLIINC, DFFICi110LDl 11 1ANOIDAII, l 1R 1TAIr 191A5UkL 1'Rll�Oi:GNI By SIGNATLIHF NI CGNTROI IN( C,1 W I wl ill H, ( ANI)II),7: 4, OR STATL MCAiu R; RROFCNFNS plete. I certmfy under FPPC Form 410 (August/2018) FPPC Advice: advicePfppc.ca.gov (866/275-3772) www.fppc.ca.gov